First Responder medications Flashcards
Comprehensive ICARDS of medications for first responders including out of scope
What are your indications for aspirin as a first responder?
Myocardial Ischemia and ST elevation myocardial infarction (STEMI)
What are the contraindications and cautions of aspirin?
Contraindications- Known severe allergy and 3rd trimester pregnancy
Cautions- Known bleeding disorder, clinically significant bleeding and worsening of bronchospasm with non-steroidal anti-inflammatory drugs (NSAIDs).
What is the mechanism of action (MOA) of aspirin?
It has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. Out-of-hospital it is administered for its antiplatelet activity.
Aspirin inhibits the enzyme cyclooxygenase which causes a reduction in the formation of prostaglandins and thromboxane
What is your routes of administration for aspirin as a first responder?
Per oral.
What is your dosages for aspirin as a first responder?
300mg
What are the common side effects of aspirin?
increased bleeding and indigestion, gastrointestinal ulceration and gastrointestinal bleeding with long term administration.
Do you have to call clinical desk to administer aspirin as a first responder?
No
What are your indications for glucose gel as a first responder?
Hypoglycemia in adults and children provided the patient can safely swallow and hypoglycemia in neonates.
What the cautions and contraindications for glucose gel?
None
What is the mechanism of action (MOA) for glucose gel?
Glucose gel provides exogenous glucose source that can be easily swallowed and rapidly absorbed.
What are your routes of administration for glucose gel as a first responder?
Per oral (PO)
What are your dosages for glucose gel as a first responder?
10-20 g
What are the common side effects of glucose gel?
None
Do you have to call clinical to administer glucose gel as a first responder?
No
What are your indications for ibuprofen as a first responder?
Mild to moderate pain, usually in combination with paracetamol and moderate to severe pain usually in combination with other medicines.
What are the contraindications and cautions for ibuprofen?
Contraindications- Known severe allergy, pregnancy, sepsis, dehydration, shock, clinically significant bleeding and known worsening of bronchospasm following non-steroidal anti-inflammatory drugs (NSAIDs).
Cautions- patient has taken ibuprofen within the last 4 hours, abdominal pain and aged greater than or equal to 75 years, particularly if frail.
What is the mechanism of action (MOA) of ibuprofen?
It is an non-steroidal anti-inflammatory drug (NSAID) predominantly used for treating pain.
It inhibits the enzyme prostaglandin synthetase reducing prostaglandin production which reduces inflammation, pain and fever.
What are your routes of administration for ibuprofen as a first responder?
Per oral (PO)
What are your dosages for ibuprofen as a first responder?
600mg for an adult over 80 kg
400mg for an adult under 80kg
refer to pediatric drug dose tables for a child.
What are the common side effects of ibuprofen?
Renal impairment, increased bleeding and indigestion, gastrointestinal ulceration and gastrointestinal bleeding with long term administration.
Do you need to call clinical to administer ibuprofen as a first responder?
If you are looking to administer a 600mg dose or liquid suspension otherwise no.
What are your indications for paracetamol as a first responder?
Mild to moderate pain and moderate to severe pain usually in combination with other medicines.
What are the contraindications and cautions of paracetamol?
Contraindications- Known severe allergy
Cautions- Taken paracetamol within the last 4 hours, abdominal pain, known severe liver disease.
What is the mechanism of action (MOA) for paracetamol?
It inhibits the production of prostaglandins resulting in a reduction in pain and fever.
What are your routes of administration for paracetamol as a first responder?
Per oral (PO)
What are the common side effects of paracetamol?
none
What are your dosages for paracetamol as a first responder?
1500mg for an adult over 80kg
1000mg for an adult under 80kg
refer to pediatric drug dosage table for a child
Do you have to call clinical desk to administer paracetamol as a first responder?
If you are looking to administer a 1500mg dose or liquid suspension otherwise no.
What are your indications for adrenaline as a first responder?
Anaphylaxis, severe asthma, stridor causing moderate to severe respiratory distress, clinically significant epistaxis, clinically significant bleeding from a wound.
What are the contraindications and cautions for adrenaline?
Contraindications- none
Cautions- myocardial ischemia and tachydysrhythmias
What is the mechanism of action (MOA) of adrenaline?
Adrenaline predominantly agonizes alpha 1, beta 1 and beta 2 receptors.
Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction, glycogenolysis and gluconeogenesis
Beta 1 stimulation causes an increase in inotropy (cardiac contractility), chronotropy (heart rate) and dromotropy (speed of electrical conduction through the heart).
Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation and reduction in histamine release through stabilisation of mast cell membranes.
What are your routes of administration for adrenaline as a first responder?
Intramuscular (IM)(anaphylaxis, severe asthma), nebulised (stridor causing moderate to severe respiratory distress), intranasal (IN)(Clinically significant epistaxis) and topical (Clinically significant bleeding from a wound).
What are your dosages for adrenaline administration as a first responder?
0.5mg intramuscular undiluted for an adult. For a child refer to pediatric drug dosage table.
5mg nebulised undiluted
0.2mg intranasal per bleeding nostril diluted to 1:10,000 with 0.9% sodium chloride for an adult. For a child refer to pediatric drug dosage table.
Any amount of solution diluted to 1:10,000 with 0.9% sodium chloride for topical.
What are the common side effects of adrenaline administration?
Tachycardia, tachydysrhythmia, myocardial ischemia, Ventricular ectopy, hypertension, nausea, vomiting, tremor, anxiety, sweating and hyperglycemia
Do you have to call clinical for adrenaline administration as a first responder?
Yes unless the patient has their own auto-injector
What are your indication for midazolam as a first responder?
Generalised seizures lasting longer than 5 minutes or are recurrent.
What are the contraindications and cautions for midazolam administration?
Contraindications- known severe allergy, aged less than 12 years (Not applicable to indications for first responders)
Cautions- Altered level of consciousness, respiratory depression, signs of shock, concurrent administration of opiates or ketamine and aged greater than or equal to 75 particularly if frail.
What are the contraindications and cautions for midazolam administration?
It is a benzodiazepine.
It enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation.
What are your routes of administration for midazolam as a first responder?
Intramuscular (IM)
What are your dosages for midazolam administration as a first responder?
10mg for an adult.
Refer to pediatric drug dose table for a child.
What are the common side effects of midazolam?
Sedation, respiratory depression, hypotension and amnesia.
Do you have to call clinical desk for midazolam administration as a first responder?
Yes